Families

According to a recent report, children exposed to chronic family stresses due to frequent fights, violence or problems associated with job loss are at increased risk of illness, especially those causing fever. Johns Hopkins and University of Rochester researchers followed 169 children aged 5-10 for three years, during which stress related symptoms, febrile diseases and total illnesses were recorded every six months. Children also had blood tests every six months to evaluate natural killer cell activity, a measure of the immune system’s response to infection. Parental psychiatric symptoms like depression, anxiety and dysfunctional behavior, as well as how successfully they handled responsibilities and relationships with their children, were rated on the 51-item Brief Symptom Inventory. Parents also reported on external events such as exposure to violence and unemployment that caused family stress as assessed by the Stressful Life Events checklist.
The results revealed that elevated family stress was associated with an 11% increase in total illnesses and a 36% increase in those that caused fevers, compared to children living in families with little stress. Most of these were due to upper respiratory tract infections (159), followed by gastrointestinal tract infections (51), and sinus infections (25). Elevated parental psychiatric symptoms occurring with family stressors were also associated with more total illnesses and febrile illnesses. Natural killer cell activity was increased in children whose parents reported more chronic family stress. Previous research had linked impaired parental function and family stress to negative effects on children’s emotional and social functioning. This study broadens these observations to include objective health and biological indicators that demonstrate a possible negative effect on immunity and susceptibility to illness in children. The authors also suggest that impaired parental functioning may be an important mechanism that explains the link between increased family stress with adverse effects on children’s health.

Reference: Wyman PA, Moynihan J, et al. Association of Family Stress With Natural Killer Cell Activity and the Frequency of Illnesses in Children. Arch Pediatr Adolesc Med. 2007; 161:228-234.

Job stress appears to be getting all the headlines, but some of those problems may have their roots in difficulties at home.  Constant arguments with family members, financial difficulties and stressful environmental conditions are common home-life stresses which spill over into professional and other activities.  Measures which can be helpful in reducing stress at home include respecting the privacy and individuality of family members, establishing and adhering to definite rules to insure this, allowing for enough time as well as a place to relax or get adequate exercise, setting realistic goals for yourself and other family members, budgeting and promoting proper financial planning, reducing annoying sound levels and other environmental disturbances, joint efforts to promote neatness and order, and a sense daily routine.  Many problems stem from unilateral inappropriate demands and expectations from other in the household.  These can often be minimized by trying to guide rather than forcing others to achieve realistic goals.  A dictatorial attitude can backfire and result in losing the kid of leadership and control you are trying to achieve.  Teenagers are especially rebellious when it comes to authority and the best results come from setting a good example in terms of lifestyle, temperament, and resilience in dealing with family disputes.

A government report indicated that while overall cancer rates are declining, there has been a disturbing upward swing in breast cancer in middle-aged women.  The reasons for this are not clear, although it has been established that women who have had children are less likely to develop breast cancer that those who have not.  Also, the younger you are when you have your first child, the better your chances for escaping this problem.  Pregnancy appears to lower concentrations of prolactin, a hormone which is known to cause breast tissue growth and contribute to malignant breast tumors in experimental animals. It has been noted that in the past few decades, more females have become career women and consequently, do not marry and become mothers, or do so when they are comparatively older.  In addition, such individuals may be subjected to various forms of job stress due to frustration in advancement or obtaining parity with male workers having equivalent skills, training and experience.  Emotional stress has been demonstrated to cause a depression in immune system defense against cancer and a variety of viral-linked disorders.  One study of women who had married between the ages of 17 and 44 revealed that those who never had children were much more susceptible to sudden death due to heart disease.  Possible explanations offered include an abnormal endocrine state which possible constributed both to infertifily and cardiac disease because of estrogen deficiancy as well as the psychsocial stres associated with being barren.  In any event, it appears that motherhood bestows certain health benefits, as well as more obvious rewards.

Most attempts to rate or quantify stress place death of a spouse or a loved one at the top of the list with loss of other important emotional relationships such as divorce, marital separation, and retirement next in line.  Death of a spouse has been shown to result in a prompt prolonged depression of immune system function possibly explaining why recently widowed individuals had 3 to 12 times higher death rates than married controls.  Recent studies now confirm that marital separation is also associated with a significant impairment in immune system function.  Women who had been separated one year or less had much greater depression of immune responses than matched married counterparts.  Among the separated-divorced group, those with greater attachment to their ex-husband exhibited the highest levels of emotional depression and poor immune system.

As noted in prior Newsletters, the Harvard Study of Adult Development is the longest and most comprehensive investigation of the aging process ever
conducted.  Since the 1930′s, researchers have closely followed more than 800 men and women from adolescence to old age to seek clues about behaviors and activities that are associated with healthy longevity.  Some of the findings surprised George Vaillant, the current director of this project and author of Aging Well.   He had anticipated that “the longevity of your parents, the quality of your childhood and cholesterol levels would be very influential”. They were not.  Keeping mentally active and having lots of friends were much more important.  A happy marriage or good long term relationship at age 50 was a leading indicator of being healthy at age 80 but a low cholesterol level had very little significance.

How can such findings be explained?  With respect to cholesterol, Newsletter subscribers are already aware of mounting evidence that elevated cholesterol, like premature baldness and a deep earlobe crease, may be associated with a higher incidence of heart attacks, but does not causethem.  Similarly, the cardioprotective benefits of statins are not due to
cholesterol lowering since they are also seen in patients with low LDL and cholesterol.  It is much more likely, that, like low dose aspirin, reduction of inflammation and other activities are responsible.  In addition, numerous studies show that cholesterol lowering is of little value in reducing mortality in senior citizens and that a low cholesterol is actually associated with increased death rates and numerous health problems.

But why would a happy marriage or having lots of friends promote healthy aging?  The most likely explanation is that stress can accelerate the aging process and that having strong social support from friends or family reduces the harmful effects of
stress.  Stress can contribute to illness and premature mortality in many ways, including suppression of the immune system’s ability to ward off infections and certain cancers. British researchers recently reported that in a study of more than 180 senior citizens who received influenza vaccine, those who said they were happily married developed higher antibodies and more protection than others who reported less marital satisfaction.  Participants also completed questionnaires designed to rate exposure to stressful life events and those who had experienced a significant bereavement in past 12 months had poorer antibody responses than controls.  A happy marriage or long term relationship also provides strong emotional support, which is a powerful stress buster.

References: References: Vaillant GE. AGING WELL: Surprising
Guideposts to a Happier Life from the Landmark Harvard Study of Adult
Development. Little, Brown and Co. New York, 2002. Health And Stress Newsletter,
#5, #7 2005, #10 2002, #7 2000, #9 1999.

A happy marriage can help you live a longer and healthier life. One of the benefits of a happy marriage seems to be improved immune system function and studies show that stress can impair immune system. Medical students who were severely stressed because of concerns about an impending important exam had lower than normal antibody responses to Hepatitis-B vaccine. A similar poor response to influenza vaccine compared to well-matched controls was seen in those caring for a spouse with Alzheimer’s.  Another study showed that such caregivers took an average of 9 days longer than controls to completely heal a small biopsy wound because of impaired immune responses.  Caregivers had higher levels of Interleukin-6, which disrupts immune system function and increases risk for heart disease, arthritis, osteoporosis, Type-2 diabetes and possibly certain malignancies. These changes can persist up to three years after care giving activities cease.

There is little doubt that having to provide constant care to a spouse suffering from Alzheimer’s can cause severe stress
that impairs wound healing and increases susceptibility to disease.  However, a recent study showed that even if spouses usually get along well, the stress caused by a brief argument can slow healing of a surgical wound by as much as a
day.  Researchers admitted 42 couples who had been married on average for 12.5 years for two 24-hour visits, separated by two months.  At each visit, all participants were subjected to a suction blister device that produced eight
identical tiny wounds. During the first visit, all couples completed questionnaires designed to measure their stress levels and were then asked to engage in two 10-minute discussions during which they were asking for and providing social support so that their behavior could be evaluated.  Theprocedure was the same during the second visit except that the 10-minute
discussions were about areas of disagreement designed to produce emotional and sometimes hostile responses.   Couples who were classified as  “high hostile” took a day longer to heal than others not only after the conflict visit (7 days versus 6) but also after the social support encounter (6 versus 5)  Differences were found in immune system cytokine measurements in the delayed healing group that could explain these results.

If a short spat in a laboratory can have such effects, one can only wonder what the response would be to a full-fledged fight at home that lasted hours or days.Frequent fights could significantly delay wound healing and reduce resistance to infection.  The Honeymooner’s Ralph Kramden was probably lucky that he never needed emergency surgery.

References:
Kiecolt-Glaser JK et al.
Hostile Marital Interactions, Proinflammatory Cytokine Production, and Wound
Healing. Arch Gen Psychiatry.
2005;62:1377-1384. BBC News Online 11/08/2005.
Health And Stress Newsletter
#7, 1999